MEDICARE: ANNY THUC NGUYEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	1041C0700X	Clinical Social Worker	ASW122471	CA

General Provider Information

NPI Number	:	1225808140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNY THUC NGUYEN

Provider Business Mailing Address
First Line	:	PO BOX 371104
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92137-1104
Country	:	US
Telephone Number	:	619-278-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3990 OLD TOWN AVE STE C201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-2933
Country	:	US
Telephone Number	:	619-278-2400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	06/10/2024

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